An exclusive interview with Health Minister Jane Philpott

In an exclusive interview for PositiveLite.com for World AIDS Day, Rob Easton talks with federal Health Minister Jane Philpott about Canada’s 90-90-90 achievements, a renewed federal initiative on HIV, criminalization of non-disclosure and more.

Photo: Motswari Mofokeng

Rob Easton: Minister Philpott, thank you for taking the time for this interview with PositiveLite.com.

Jane Philpott: My pleasure.

You’ve had a very busy few weeks with health accords and a number of different announcements. How challenging is it to get HIV on the list of priorities, both within your ministry, and also around the cabinet table?

I think it would be fair to say that HIV and other sexually transmitted and blood born infections have not been a big priority for the federal government over the past decade. But it’s something I’ve had a long commitment to addressing. HIV is one of the biggest global public health challenges we face, and it’s an issue on which I think Canada can, from a global perspective, play a very strong leadership role. But we also have a lot of work to do from a domestic perspective. The rates of new infections in this country have not substantially changed in two decades. At the end of the day, HIV is a preventable, treatable infection, and we have a lot of work to do, and it’s something I’m personally committed to doing. I have the support of the prime minister and the cabinet in doing so, and in making it an issue that we’re determined to address.

What sort of commitments, specific measures, are we talking about here? Are there new things coming?

One of the first things that I think is important is for us to understand the scope of the challenge that we’re facing in Canada. You’re probably aware of the UNAIDS global targets, the 90-90-90 targets, which, on World AIDS Day last year, I announced that the federal government was endorsing. This was greeted by the community as good news. In fact, it has its roots in the treatment as prevention approach pioneered by a Canadian, Dr Julio Montaner. And Canada has stepped up and said, yes, we’re trying to reach those targets.

I was a little surprised to realize that we actually had quite a bit of work to do even to be able to identify where we’re currently at with those targets. There hadn’t been a concerted effort at the federal level to try to figure that out. So I asked the Public Health Agency to bring together public health leaders from the provinces and territories to crunch the data so we’d be able to determine how we’re doing on all of those targets. By World AIDS Day this year, I wanted to have their best estimates of how we’re doing, because we won’t be able to improve our numbers and reach those targets unless we understand where we’re at.

And how are we doing?

They’ve done a lot of work to try to gather the data to the best of their ability. There are still a few challenges and a little bit of variability on how close we are on the numbers. But on Thursday, World AIDS Day, we’ll be announcing that we’re at 80% on the first 90, which means that 80% of HIV-infected people in this country know their status, four out of five. On the second 90, which is those who know they have HIV and are on treatment, we’re not doing as well, we’re at 76%. We’re doing better on the last 90, though, because our best estimate is that 89% of people on treatment have suppressed viral loads. So that’s good news that we’re getting people to viral suppression.

As we know, this is a cascade, so we need to start with the first 90, getting people to know their status. How do we address that?

You’re absolutely right, it is a cascade, so the first step is making sure people do know their status. There’s been some good work done in certain communities across Canada within my portfolio, with the First Nations and Inuit Health Branch for example. They have run a few pilot projects across the country called “Know your Status” to encourage particular communities and vulnerable populations to do better at making sure that people are getting tested.

One of the things I and a number of my colleagues will be doing first thing on World AIDS Day is we’re going for a rapid HIV test at one of the local community health centres. It’s a way of helping to normalize routine HIV testing, to help people learn about how easy it is to get tested, and to encourage people to find out what their status is. That’s obviously a bit of a symbolic event, but it’ll launch us into working on a more pan-Canadian strategy to make sure that people do know their status.

You mention a pan-Canadian strategy. Is one in the works, with all the provinces on board?

What we do have, and you might be familiar with this, is a federal initiative on HIV and Hepatitis C and other sexually transmitted and blood born infections, that hasn’t had a lot of attention in recent years. It brings together the work of the different agencies within my portfolio, the Public Health Agency of Canada, the research work done by the Canadian Institutes of Health Research, and the work done by Indigenous Canadians. I think that it’s time for a renewal of our federal approach, to renew how we work with the provinces and territories and other stakeholders on the matter. So I’ve asked the Public Health Agency of Canada to convene a meeting in February where they’ll bring together stakeholders and experts to talk about how we can do better at all of the things that need to be done, prevention, treatment, care.

You’re a medical doctor and also, obviously, someone who’s very well versed in the file. Are you a firm believer in treatment as prevention, and pre-exposure prophylaxis? The fact that, as we know from the latest scientific research, people on treatment who have an undetectable viral load are essentially uninfectious?

The science is very strong in support of treatment as prevention. I think we need to address the pandemic from a number of perspectives and treatment as prevention is one of a number of tools that we have to put in place. I think it all starts with us looking at vulnerable populations, and recognizing who’s at risk, and what we need to do in the area of stigma and discrimination, which are known to be major drivers of the epidemic. You go from there to working on preventive work, on treatment and care.

You mentioned addressing stigma. One of the big drivers of stigma in this country is the use of the criminal law to prosecute people for non-disclosure. That’s still happening at a time when many in the community are arguing that having to wear a condom when one is undetectable goes against the scientific evidence of it being very, very, very unlikely you’d transmit HIV in that circumstance. I know it’s outside your portfolio, but I also know you’re at the cabinet table, is there anything happening with the federal government to address that particular aspect of HIV?

Absolutely. I’m glad you’ve raised that issue. It’s something that we’ve definitely recognized. I’ve spoken to my colleague, the minister of justice, about it. The Department of Justice is looking at what the best approach to address this would be. We’re hoping for some action on that very quickly. It’s something that was raised at the International AIDS Conference in Durban this year, that Canada still has work to do in the matter of criminalization, and it’s absolutely one of our priorities to address this.

One of the concerns I’ve heard about the PHAC funding approach is the shift to a more prevention focus. Yet people living with HIV, including those who are newly diagnosed, still need support services.

I don’t think that it benefits anybody to pit prevention against treatment against the work on stigma against the work on the social determinants of health, etc. I think everything has to be looked at together. My intention is to continue to work with the organizations within my portfolio, and with all of our partner groups across the country, to make sure that all of these particular aspects are addressed. I’m looking forward to that meeting in February that the Public Health Agency will be hosting, where we’re going to do a bit of a rethink on whether or not the agency and its partners have the right approach, how we’re going to prioritize, what our actions should be, in renewing our approach from the federal perspective.

One of the most exciting tools around HIV prevention is pre-exposure prophylaxis, or PrEP. It’s a highly effective means of preventing HIV, of helping negative people who are at high risk of infection to stay negative. But it’s expensive. How can the federal government ensure that people who need it, particularly those people who would benefit from it the most, have access to it?

I think that’s an important question. It’s something that we have work on. I’ve certainly raised this with my department, to look at mechanisms to make it more affordable. Certainly, within the First Nations and Inuit Health Branch, while there’s a lot of work to be done, we’ve made it very clear that we want it to be available as an important preventive tool for people covered under the benefit plans associated with it. But there’s work to be done with the provinces and territories in this matter as well. So, I’ll acknowledge that there’s some challenges around that related to cost. But it’s definitely a much under-utilized tool, and we have to find a way to make it more available to the people for whom it makes sense.

And then there’s the other side of that coin too. I mean, HIV meds for treatment are not cheap either. While most public and private drug plans cover it, the deductible associated with it can be sometimes be a barrier. Treatment is the second 90. How can we make sure that treatment is accessible for everyone?

Well, you know, you’re absolutely right. It’s maybe one of the reasons why our numbers are not as good as they ought to be in terms of who’s on treatment. As you know, the drug plans vary across the country, but one of the roles of the federal government is its convening power, where the Public Health Agency of Canada can be helpful in talking with other public health agencies across the country to find some uniformity in terms of our approach. Because we know, for instance, that treatment as prevention does work, that there’s a tremendous amount of value in terms of getting people on treatment as one of the tools to minimize the spread of infection. So, absolutely, it’s one of the things on our to-do list.

I hear a lot of great things on your to-do list. It sounds like you’re definitely well aware of what needs to be done. What about committing dollars to these things, when does that happen?

Well, in fact we hope to be able to increase our support for the work of addressing HIV along with Hep C and other sexually transmitted and blood born infections. I think our approach to HIV and Hep C needs to be done in harmony for a variety of reasons. It’s an area where I’d like to be able to increase resources, so it remains to be seen how effective we’ll be on that. It’s definitely something that I acknowledge we’d like to do.

Can you tell me a little more about the strategy of lumping HIV and Hep C in together?

Some of the risk factors, while they’re not entirely the same, they are similar, so approaches to help prevent the spread of HIV will also often help to prevent the spread of Hep C, and vice-versa. This has been born out by other countries around the world. The Public Health Agency thinks it makes sense to have a harmonized approach to sexually transmitted and blood-born infections. I think it’s a case of trying to find some measure of efficiency, and to be able to serve the people that need to be served.

And we can expect that this will be part of the discussions at that February meeting as well?

That would be the lens from which we will discuss the steps going forward.

Minister, thank you for this.

You’re welcome.

This interview has been edited for clarity.

Rob Easton (right) is a Toronto-based freelance journalist who follows an LGBT-focused beat for cbc.ca, DailyXtra, Canadaland, and others.

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